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Survey Report

Chapter 3 — ABHP sponsorship is peaking, HSAs expanding

2018 Best Practices in Health Care Employer Survey

Global Benefits Management|Health and Benefits
N/A

January 3, 2019

Find out how U.S. employers are managing health care costs and addressing employee wellbeing to achieve a healthy, high-performing workforce.

Sponsorship rates

Account-based health plans have increased in prevalence over the past decade. Today, 81% of employers offer ABHPs. In contrast, only 47% of employers offered ABHPs in 2008. We are reaching a saturation point as the availability of these plans is anticipated to only go up three points to 84% next year.

Currently 21% of employers offer ABHPs as their only plan, up from 19% in 2017. Growth of total replacement is expected to remain stagnant next year as only 22% of employers expect to only offer ABHPs (Figure 8).

Bar graph: Has ABHP sponsorship peaked?
Figure 8. Has ABHP sponsorship peaked?

*Planned for 2019
Note: 2006 is based on the 12th annual Willis Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care; 2007 is based on the 13th annual survey, and so on.
Sample: Based on respondents with at least 1,000 employees

Rethinking total replacement ABHPs

Total replacement has lingered around one-fifth of employers since 2015, and now, employers are beginning to rethink the total replacement strategy.

Nearly one in five (18%) employers that had previously offered only ABHPs have reinstituted a choice of plan options where ABHPs are an option along with low point-of-care cost plans (Figure 9). Furthermore, another 14% of employers that adopted total replacement are expecting to add back low point-of-care cost plans in the next two years.

Chart: Nearly 20% of employers have eliminated their total replacement ABHP strategy
Figure 9. Nearly 20% of employers have eliminated their total replacement ABHP strategy

Note: Percentages indicate “Used in 2018,” “Planning for 2019” or “Considering for 2020”
Sample: Based on respondents with at least 1,000 employees that offer ABHPs

Icon: yellow star

Best practices: ABHP

  • Offer plans that will have affordable premiums and point-of-care costs for the entire range of employees.
  • Provide initial contribution to ABHP-associated savings account (HSA or HRA), and consider differential contribution for low-wage workers.
  • Provide decision support to help employees choose the best plan and amount to contribute into a savings account.
  • Communicate and educate on the value of saving and the connection to other saving vehicles such as 401(k)s.
  • Shop carefully for an HSA vendor: The best deal for your organization and employees is not always the carrier’s partner.

HSAs expand, but some employers hold on to HRAs

Employers offering HSAs with their ABHPs stand at 93% in 2018 up from 90% in 2017 (Figure 10). In contrast, 29% of employers with ABHPs offer HRAs in 2018 down from 32% in 2017. Those figures include the 23% of employers that offer both HSAs and HRAs in 2018 and 2017. The number of employers offering only HRAs now stands at 6%, down from 9% in 2017. These figures are in a stark contrast to a decade ago when nearly as many companies offered HSAs (61%) as HRAs (59%) when including the 20% of employers offering both. We expect our future results for HRA use could change pending a proposal by the Trump administration to promote HRA availability.

Although many employers offer ABHPs along with other plans, most organizations find ways to nudge employees toward choosing the ABHP option such as charging lower premiums than other plan options, and 65% contribute funds to an employee’s HSA to help defray the higher point-of-care costs (Figure 11).

Bar graph: HSAs continue to expand among employers with ABHPs
Figure 10. HSAs continue to expand among employers with ABHPs

Sample: Based on respondents with at least 1,000 employees that offer an HSA- or HRA-ABHP

Bar graph: Over four out of five companies plan to offer an HSA-based ABHP by 2020
Figure 11. Over four out of five companies plan to offer an HSA-based ABHP by 2020

*Includes companies indicating “Planned for 2019” or “Considering for 2020”
Sample: Based on respondents with at least 1,000 employees with or without an ABHP

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